Saturday, January 9, 2021

How do we know how good our treatments are? reflections on PROMS

Meaningful Clinical Applications of Patient-Reported Outcome Measures in Orthopaedics

The bullet points provided by this author are:

*Patient-reported outcome measures (PROMs) comprise valuable data, when combined with traditional clinical information, for patient-centered health outcome assessment.

*While PROMs form the foundation of orthopaedic clinical research, they are invaluable tools for clinical care.

*PROMs play a critical role in shared decision-making with patients, as they are quantitative measures of patient health (function, pain, and satisfaction).

*PROMs should be incorporated into routine postoperative care for effective clinical monitoring and understanding of the response to surgery.

*PROMs can be additionally utilized for meaningful clinical research, predictive analytics, and value-based care delivery pathways.

Comment: Here are few reflections on this subject.

(1) PROM may not be the best name. We should be concerned not only about the "outcome" (patient reported OUTCOME measure), but also the status of the patient prior to treatment, the "ingo" in that the benefit of treatment is measured by the pretreatment to post treatment difference recognized by the patient. Thus a preferred term is PRMCF (patient reported measure of comfort and function). It is of interest that many orthopaedic articles report the results of treatment in terms of the post treatment "PROM" without recognition of the pre treatment status.

(2) Doing a good job of collecting these data requires a commitment of time and money. Someone has to have the responsibility for collecting and entering the data in a secure and HIPAA compliant way. It is critical to capture the data on the highest possible percent of the patients of interest for the duration of interest. While 80% five year followup sounds great, in actuality it does not give information on one out of every five patients - why did they not follow up? - those patients lost to follow may all have had disastrous outcomes. We cannot assume that the data on 80% can be extrapolated to the entire initial study group. For this reason the choice of PRMCF tools needs to result the the capture of the highest percentage of patients (not only those who have access to and who can use a PROMIS CAT).

(3) The best reason for a surgeon to collect preoperative and postoperative PRMCFs on her or his patients is to learn what treatments work for which conditions and which patients in the hands of that specific surgeon. These data have two important values: (a) the surgeon can let prospective patients know the results that surgeon has achieved (rather than results from some other place published in a journal) and (b) these data enable the surgeon to refine her or his practice by avoiding the patient-diagnosis-procedure combinations that don't work in their hands. 

(4) Another reason for collecting preoperative and postoperative PRMCFs is to participate in multi center studies. This requires careful coordination to assure document of the characteristics of the patients, their diagnoses, their treatment, and the approach to capturing followup data. 

Careful and comprehensive collection of pretreatment and post treatment PRMCF's is the key to our being better surgeons.

Codman wrote, "follow every patient..., long enough to determine whether or not the treatment has been successful, and then to inquire, ‘If not, why not?’”

To support our research to improve outcomes for patients with shoulder problems, click here.
To subscribe to this blog, enter your email in the box to your right that looks like the below

How you can support research in shoulder surgery Click on this link.

We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art" regarding this radically conservative approach to shoulder arthritis at this link and this link

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages  arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'